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Overlooking Women’s Health in Northern Nigeria| by Aisha Mukhtar Dodo

“From 2012 to 2015, Nigeria’s health budget consistently remained at around a paltry 6 per cent of the national budget; with a decrease to 4.64 per cent in 2016. This is despite pledging to commit 15 per cent of the national budget to the health sector at the Abuja declaration in 2001. One of the consequences is that an estimated 900,000 Nigerian women and children die annually from mostly preventable causes.”

the North-East region of Nigeria has the highest maternal mortality rates in the country. Out of 100,000 live births, 1,549 mothers die in the North East compared to 165 in the South West; a nearly 10 fold difference.

Compared to a national female literacy rate of 51 per cent, literacy rates for women are as low as 5 per cent in some northern states. Literacy rates among women in the states of the North-East and the North-West range between 7.2 per cent and 55.7 per cent compared with a range of between 90.1 per cent to 96.4 per cent in the states that comprise Nigeria’s South-East, South-West, and South-South regions. The impact of such low levels of literacy and education among northern women on health outcomes for females in the region is enormous; and negative.

As a result of below modest investment, Nigeria’s health system is less effective compared to other African countries. From 2012 to 2015, Nigeria’s health budget consistently remained at around a paltry 6 per cent of the national budget; with a decrease to 4.64 per cent in 2016. This is despite pledging to commit 15 per cent of the national budget to the health sector at the Abuja declaration in 2001. On the other hand, significant health and economic improvements have been achieved with modest investments by countries such as Rwanda, Malawi, and Botswana, which allocated 18 per cent, 17.1 per cent, and 17.8 per cent of their respective budgets to healthcare.

an estimated 900,000 Nigerian women and children die annually from mostly preventable causes

There is a chronic lack of adequate health services, coupled with poorly equipped facilities that lack basic essential medicines. Additionally, the dearth of skilled health workers in the North and inaccessibility of health facilities due to distance and poor road networks results in poor health status for the population, particularly for women and children.

The highest neonatal mortality within Nigeria – that is, the death rate of infants within the first 28 days of life – is in the North East and North West regions. The highest death rate of under five children is also in the North-East and North-West regions.

The poor state of healthcare for women in northern Nigeria is not confined to general demographic issues of fertility and maternal mortality. The prevalence of specified gynaecological conditions like breast and cervical cancer, and Vesico Vaginal Fistula (VVF), is on the rise among women in northern Nigeria.

In Nigeria, cervical cancer is the leading cause of cancer-related deaths in women. It is second only to breast cancer as the most common cancer in Nigerian women. The increasing number of deaths from cancer is the result of a general lack of public awareness about the disease, as well as poverty. Coupled with the limited number of screening programmes that exist in Nigeria, the outcome is often late diagnosis of the disease after it has already spread to other organs and become untreatable.

In North-East and North-West regions respectively, approximately 32 per cent and 35 per cent of girls aged 15-19 have started childbearing

While incidents of VVF and cervical cancer are increasing, partially as a result of early marriage in girls between the ages of 12 and 18 years, most cases are due to poverty, illiteracy, and poor obstetric services. In an ideal scenario, finding a cure to these diseases is the ultimate goal both in the global and the Nigerian medical communities. Presently, however, the focus must be on prevention.

The Population Commission’s study found that the practice of FGM varies with levels of education and socio-economic status. Unsurprisingly, those with higher levels of education and higher socio-economic status are also those least likely to believe that FGM is required by their religion.

It is clear that outreach programmes are needed to provide basic education on the problem of FGM; particularly where rural populations that still practice female genital mutilation are concerned.

But besides the fact that urgent attention is now needed to address the issues of poor and under-utilised healthcare facilities, issues such as poor access to minimally existing medical services are further compounded by social, normative, and economic factors that include – but are not limited to – gender inequality in many areas of the North.

A holistic approach to solving the problems of female-orientated healthcare in northern Nigeria cannot, and should not, ignore these facts.

Moving Forward

Improvement to the health quality and well-being of women in northern Nigeria is urgent and achievable. Swift infrastructural development including the building of passable roads, as well as safe and accessible water sources, is absolutely essential.

The highest neonatal mortality within Nigeria – that is, the death rate of infants within the first 28 days of life – is in the North East and North West regions. The highest death rate of under five children is also in the North East and North West regions.

Interventions by both public sector policy makers and development workers should be designed and implemented with due consideration to the socio-cultural norms and beliefs that are prevalent in northern parts of Nigeria. These will be successfully implemented when done in collaboration with the relevant religious and community stakeholders. The education of males, and those in authority, in northern communities about the importance and impact on the whole society of female health is also vital. The wide-ranging problem of low education levels must also be urgently addressed.

Aisha Mukhtar Dodo is a Nigerian from Katsina State. She is currently a Ph.D. candidate in Public Health at Cardiff Metropolitan University where her research is focused on bridging the cultural gaps in cancer management in northern Nigeria.